Menstruation

Prepared by:mayy Naser and manar ghnematTo : Dr ikhlas jarar

Introduction

Menstruation:• Is a physiological discharge of

blood ,endometrial cellular debris , and mucus through the vaginal of non pregnant woman and is result of monthly cycling of female reproductive hormone.

• Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). The average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal

PHYSIOLOGY OF MENSTRUAL CYCLE

The normal menstrual cycle is divided into:1.The ovarian cycle.(1)The follicular phase (day 1 to 13(2) Ovulatory phase (day13 to15) (3) The luteal phase (day 15 to 28).2. The uterine cycle.

Menstrual abnormalities

• 1. Dysmenorrhea• 2.Amenorrhea• 3.Intermenstrual pain• 4. PMS (premenstrual syndrome)• 5. Menorrhagia

dysmenorrhea

• 1. dysmenorrhea: is painful menstruation .• Types: • primary dysmenorrhea : associated with

menstruation in the absence of pelvic disease.

• Increase the level of prostaglandins in the menstrual fluids.

• Secondary dysmenorrhea :associated with pelvic disorder.

• Causes: PID, ovarian cysts ,endometriosis.

Symptoms of dysmenorrhea

• Abdominal cramping: usually begins at onset of menstrual flow a few hours before onset

• Nausea• Vomiting • Diarrhea • Headache• dizziness

Treatment

• 1. Analgesics for the relief of cramping with premenstrual syndrome and use for mild to moderate pain.

• Acetyl salicylic acid.• NSAIDS: inh. Synthesis of PG because

PG are responsible for cramping of dysmenorrgea.

• Ipoprofen 200mg every 4-6 hr .• Naproxen 200 mg every 8-12 hr.

• 2.Diuretics:by FDA , used in eliminating water during premenstrual and menstrual periods.

• 5 days before menses , diuretics help relieve bloating , excess water , cramps , and tension.

• 1-ammonium choride:3g per day in 3 divided doses.(large doses cause GI symptoms

• 2-caffeine:promotes diuresis by inh. Tubular reabsorption of sodium & chloride.

• 3-pamabrom: 50 mg four times daily(not exceed 200 mg per day)

Amenorrhea

• Is the absence of menstruation • Primary or secondary amenorrhea requires

physician evaluation

Intermenstrual pain and bleeding

• Occur at mid cycle and may last for hours to days.

• Pain associated with ovulation .• Therapy consists of nonprescription

analgesics.• Patients with pain lasting longer than

2 days should be referred to a physician.

Premenstrual Syndrome(PMS)

• Symptoms : mood swings , fatigue , appetite change , bloating , breast tenderness , irritability , depression (begin 1-7 days before the onset of menses.

• Nonpharmacological therapy:• Dietary modification , regular exercise ,

reduction of stress factor , avoiding caffeine , fruits and vegetable consuming and avoid salty food.

Pharmacological treatment

• Diuretic• Benzodiazepines , (MAO-I) , (TCA) , selective

serotonin reuptake inhibitor .• Fluoxetine : is FDA approved and used for

premenstrual dysphoric disorder.• Calcium supplements : to reduce emotional

and physical symptoms of PMS.

Menorrhagia

• Excessive menstrual blood loss• Low hematocrit , low hemoglobin , low

serum iron may occur ( lead to anemia)• Treatment is usually estrogen – progestin

combination (oral contraceptive)

Toxic Shock Syndrome

• Can categorized by menstruation or non menstruation.

• Affect woman less than 30 years , women 15-19 at high risk.

• Occurs in women \men contagious• Mainly staphlococcus Aureus infection .• Related to use of tampons. And contraceptive use• S&S : flue like , fever , diarrhea , vomiting ,abrupt

onset ( 8-12 hr)

VAGINAL PRODUCTS

• A. Vulvovaginal candidiasis• 1. General considerations

• a. Occurrence:.Approximately 75% of all women will experience vulvovaginal candidiasis (yeast infection)

• b. Cause.Candida albicansis responsible for up to 92% of infections.

• c. Predisposing factors: .Antibiotics, oral contraceptives • containing high-dose estrogen,pregnancy, diabetes,and

immunosuppression in-crease the risk for infection.

• d. Symptoms.Can include a thick, white, ‘‘cottage cheese–like,’’; vaginal burning; and pruritus.

Patient assesment

• (1)First episode of symptoms• (2)Pregnant• (3)Younger than 12 years of age• (4)Systemic symptoms such as fever• (5)History of recurrent vaginal yeast infections• (6)Discharge with a fishy odor (indicates bacterial

vaginosis, most often caused by• anaerobic bacteria

. Pharmacological treatment

• include • intravaginal creams, suppositories, and ointments.• d.External vaginal creams can be used in combination with

intravaginal products to treat• vulvar symptoms of pruritus.

Otc products

• Mycelex-T (clotrimazole), • Monistat 3 and Monistat7 (miconazole),• Femstat 3 (butocona-zole),• and Monistat 1 and Vagistat 1 (tioconazole).

. Nonpharmacological

• (1)Dry vaginal area well after bathing with a towel.• (2)Avoid tight or damp clothing.• (3)Wear cotton underwear.• (4)Use unscented soap to avoid irritation.• (5)Avoid douching.